Provider Demographics
NPI:1659565877
Name:TERESA M TSE DMD PC
Entity Type:Organization
Organization Name:TERESA M TSE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:671-482-8550
Mailing Address - Street 1:128A TREMONT ST
Mailing Address - Street 2:5TH FL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-4716
Mailing Address - Country:US
Mailing Address - Phone:617-482-8550
Mailing Address - Fax:617-695-3824
Practice Address - Street 1:128A TREMONT ST
Practice Address - Street 2:5TH FL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4716
Practice Address - Country:US
Practice Address - Phone:617-482-8550
Practice Address - Fax:617-695-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA137371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9721835Medicaid